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Republican Health Platform Shows Differences Between Party, Trump

July 19 — The Republican party platform reads like a wish list of traditional Republican health-care
goals, but notably omits two of Donald Trump's most controversial health-care ideas—allowing
Medicare to negotiate drug prices and drugs to be imported.

The
platform, unveiled July 18, includes familiar Republican language about making premium support
an option for Medicare beneficiaries and turning Medicaid into a block grant system.
It talks about repealing the Affordable Care Act, and has some broad ideas on what
could replace it.

But notably, the platform doesn't mention allowing Medicare to negotiate drug prices,
or importing drugs from overseas, two key ideas that the presumptive Republican nominee
has backed throughout the primary process.

The platform isn't very specific, but most closely resembles the health-care plan
put forward by House Speaker Paul Ryan (R-Wis.) in June, rather than the ideas espoused
by the Trump campaign. The Ryan plan, released June 23, is meant to be a blueprint
for conservatives to follow should they have control of both Congress and the White
House (121 HCDR, 6/23/16).

Julius Hobson Jr., a senior policy adviser for Polsinelli PC in Washington, told Bloomberg
BNA it appears the Trump campaign took a back seat in the crafting of the health portion
of the platform.

“I don’t see this as any different than what Ryan and company have been pushing. There's
not enough detail to show how legislation will be crafted, nor should anyone expect
there to be,” Hobson told Bloomberg BNA July 19. He added there's “more detail in
platform than we’ve ever heard out of Trump’s mouth. He’s just not been a candidate
of specifics and won’t be nailed down on specifics. ”

Intraparty Friction

“It's clear that Trump won’t stick to his script,” Dan Mendelson, president of the
consulting firm Avalere Health, told Bloomberg BNA July 19.
“As a platform, it gives him the flexibility to get into more detail as he likes.”

Hobson said he also doesn't think the platform will limit Trump in any way. Trump
hasn't hesitated to criticize members of his own party who disagree with him, and
if he becomes president, he could have an especially caustic relationship with Congress,
Hobson said.

“Drug prices negotiation and re-importation are two shining examples of where he’d
have friction with his own party,” Hobson said.

Some early examples of that friction may already be playing out. During a panel discussion
at the Republicans' convention in Cleveland on July 19, House Ways and Means Committee
Chairman Kevin Brady (R-Texas) said congressional Republicans wouldn't agree to let
Medicare negotiate prescription drug prices.

“Study after study shows that that will save no money,” Brady said. “There's a simple
reason. If you follow the [Department of Veterans Affairs drug pricing] model, which
is what's proposed for Medicare, this is how they save money: They don't allow breakthrough
drugs, that may be more expensive, so they limit the medicines that are available,
and they limit how veterans can get them. They limit access.”

Flexibility

Mendelson of Avalere told Bloomberg BNA the platform leaves a lot of flexibility for
Trump to get into the details of his health policy during the general election campaign—
if he wants to.

Trump has run his presidential campaign on a platform of very little policy experience,
which could open the door for Congress to set the policy agenda when it comes to replacing
the ACA. Policy experts and former Republican officials have said Ryan's plan could
have a major impact—if Trump chooses to endorse it (111 HCDR, 6/9/16).

“I think this platform reflects the thinking in the House. Ryan has a very close relationship
with the Republican policy elite, so that’s where the thinking is likely to concentrate
even if Trump wins,” Mendelson said July 19.

Repeal Obamacare

Like Ryan's plan, the platform calls for an immediate repeal of the ACA.

“[A] Republican president, on the first day in office, will use legitimate waiver
authority under the law to halt its advance and then, with the unanimous support of
Congressional Republicans, will sign its repeal,”
the platform states.

It blames Obamacare for high drug prices, and promises “price transparency” for consumers.
The platform says the ACA imposed almost $30 billion in taxes over the past decade
and its cost-shifting raised prices for drugs purchased in the private market.

“To simplify the system for both patients and providers, we will reduce mandates and
enable insurers and providers of care to increase healthcare options and contain costs.”

The platform also promises tort reform to curb medical malpractice lawsuits against
physicians, and calls for reforming the Food and Drug Administration to cut down on
red tape in order to speed drug approvals.

“The FDA needs to return to its traditional emphasis on hard science and approving
new breakthrough medicines, rather than divert its attention and consume its resources
trying to overregulate electronic health records or vaping,” the platform states.

To contact the reporter on this story: Nathaniel Weixel in Washington at
nweixel@bna.com

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